Timeouts in the Operating Room: Are They Really That Important?

• Wondering if timeouts in the operating room are important? We’ve got you covered!
• With the use of technology and antibiotics in today’s surgical setting, procedures are becoming much safer.  
• Given that most people have an average of seven to nine surgeries in their lifetime, a patient’s safety must be of utmost concern the entire time they are in the hospital. 
  

What Can Go Wrong in the Operating Room?

Patients having a right knee replacement wind up getting the left done.  

A kidney transplant may happen on the wrong side.  

Sometimes, an instrument or sponge has been left inside the patient. There are also cases where the wrong patient was taken back to surgery due to a like-name or procedure. 

Medication errors occur when the patient chart is not accurate, or personnel miss the allergy.  

Sometimes the surgeon or anesthesiologist will want a specific drug to be used, and the circulating nurse must verify that it is safe for the patient to have before it is administered. 

How Do We Keep Our Patients Safe in The Operating Room?

Timeouts in the operating room ensure that all team members are aware of all details necessary to provide safe patient care.  

The circulator starts with interviewing the patient in pre-op; verifying the patient’s name and birthday is just the start. 

We also ask about the procedure, while ensuring that the site is marked correctly, allergies are noted, the last meal has been consumed, and a family history has been taken, all while checking that everything in the chart is up-to-date and accurate.  

After confirming all responses, we roll the patient into the operating room. 

Entering the Operating Room – First Timeout

Upon entering the operating room, we introduce everyone to the patient and tell them the specific job that person has – circulator, scrub, or anesthesia.  

The patient then states their name and birthday again as well as the procedure they are having.  

This is our first check that we have correct patient and procedure.  

After all is deemed correct, the patient moves onto the OR table so the anesthesia team can work their magic.

White Boards in the Operating Room

For every procedure, we list the patient’s name and birthday, procedure and side marked, allergies, and any special issues on the white board.  

When the first timeout is performed, all staff should stop and follow along to ensure that all of the information is correct after just hearing it from the patient.  

If there is any disagreement, we stop and verify before moving forward with the surgery.

Starting Surgery – Second Timeout

After the patient is prepped for the procedure, the circulator calls another timeout before the scalpel is handed to the surgeon. This timeout is long, but informative.  

Verification of the patient’s name and birthday is repeated once more. Following, the team will validate that the site is marked correctly, any patient allergies are noted, as well as a record of last meds given and lab values, again.  

Additionally, the team assesses and determines if the procedure will cause a fire risk. From there, we will take note of where the fire extinguisher is located.  

Any necessary imaging is already on the screen to be reviewed by the surgeon before the procedure. 

Extra supplies and equipment issues are also noted.  

From here, the anesthesiologist will confirm the American Society of Anesthesiologists (ASA) Physical Status Clarification System, which uses numbers one through six to determine the patient’s pre-anesthesia medical comorbidities.  

For example, one can be a healthy patient and a six typically means that a patient is brain-dead.  

They also verify that the prophylactic antibiotic has been given before the procedure, if necessary.  

The surgeon then follows with his plan for the procedure, how long it will be, and how much blood loss may occur.  

Lastly, everyone goes around the room and introduces themselves and their job to the people who are new or just joining the operating room. 

If everyone agrees, the procedure may begin.

Finishing Surgery – Third Timeout

The final check occurs when the surgery is finished.  

All team members are present for this last check to ensure that everything was performed correctly. Either the nurse or surgeon can lead this timeout. 

They will begin with patient verification of name, birthday, and the procedure site.  

From there, blood loss is confirmed by surgeon and any specimens are reconciled and labeled correctly. The counts for instruments, sponges, and needles are verified as correct, ensuring nothing is left behind in the incision. Broken equipment is taken to the main desk and sent for repair.  

As the patient leaves, their chart and any personal items should be placed on the bed to go with them to recovery. 

Universal Protocol

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) started the Universal Protocol in 2004 to facilitate better communication between team members and their patients.  

The protocol has lowered the number of wrong procedures, wrong sites, and wrong patients by around 50%.

Using the three stops during an operation facilitates verification of the information given by both the patient and the team members, allowing everyone to be on the same page for any surgery or procedure. 

Patient safety is paramount, so there should be no surprises with any surgical procedure. Staff should know what to expect in any situation.  

If all team members use these protocols, not only does the patient have a positive experience, but the number of errors is reduced significantly. These lead to a safer work environment and an integrated approach that enhances patient care.

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